Provider Demographics
NPI:1336234616
Name:EARL, JARVIS (MD)
Entity type:Individual
Prefix:
First Name:JARVIS
Middle Name:
Last Name:EARL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 NASHVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1105
Mailing Address - Country:US
Mailing Address - Phone:806-725-5844
Mailing Address - Fax:806-723-6532
Practice Address - Street 1:5419 N LOVINGTON HWY STE 31
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-9136
Practice Address - Country:US
Practice Address - Phone:575-392-5191
Practice Address - Fax:575-492-1881
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01048144207X00000X
NMMD2018-0765207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1K0450OtherMEDICARE
NM1336234616OtherBCBS
IN151560TTTTMedicare PIN
200038817Medicare PIN
INM400031095Medicare PIN
INW82031Medicare UPIN
IN151700BBBMedicare PIN
IN200229530Medicaid